Prospective Randomized Evaluation of Viewing CT-Based Immersive Virtual Reality Imaging Prior To Laparoscopic/Robotic Partial Nephrectomy: Impact on Surgical Planning and Outcomes "Presentation" - Eman Chaudhri
April 28, 2025
Eman Chaudhri discusses a randomized study of 32 patients with T1a renal masses which shows that supplementing standard CT imaging with immersive virtual reality models significantly improves surgical planning for partial nephrectomy. The clinical benefits are substantial, with the CT-plus-iVR group experiencing a 48-minute reduction in operative time compared to the CT-only group.
Biography:
Eman N. Chaudhri, MD, Department of Urology, University of California, Irvine, Irvine, CA
Eman N. Chaudhri, MD, Department of Urology, University of California, Irvine, Irvine, CA
Read the Full Video Transcript
Eman Chaudhri: Dear viewers, my name is Eman Chaudhri, and I am the leadership and Innovation fellowship training program research scholar here at the University of California, Irvine Department of Urology. It is my pleasure to present our prospective, randomized evaluation of viewing a CT-based, immersive virtual reality prior to laparoscopic or robotic partial nephrectomy, and its impact on surgeon approach and outcomes.
Review of cross-sectional computed tomography, or CT imaging, is crucial for surgical planning prior to a laparoscopic or robotic partial nephrectomy. Recent advances in immersive three-dimensional virtual reality, or 3D iVR modeling, enable the distillation of thousands of CT images into a spatially accurate model, wherein the surgeon can selectively interact with the renal anatomy.
Herein, we evaluated the impact on surgical outcomes of viewing the CT plus a 3D iVR model prior to a partial nephrectomy versus viewing the CT alone. Between 2020 and 2024, 32 patients with a clinical stage T1a renal mass undergoing a minimally invasive partial nephrectomy were randomized into one of two groups, either CT plus iVR model or CT only.
CT scans were utilized to create iVR models utilizing 3D Slicer software. In the CT plus iVR group, the surgeon was able to view and manipulate 3D anatomical components of the model using a Meta Quest headset, as seen here to the right.
Surgeons are able to put on the Meta Quest headset and reposition the anatomical model as they prefer. They are also able to immerse into the separate structures of the model. Additionally, surgeons are able to remove anatomical components as they prefer and move the model to their liking. They are also able to look at the contours of the tumor anatomy and appreciate its relationship to other intrarenal structures.
Surgeons are also able to appreciate structures separately and move them around. Surgeons' appreciation of the surgical anatomy was assessed via Likert-scale surveys. Postoperative parameters, including operative time, ischemia time, hospital stay, and complications to the Clavien-Dindo classification were analyzed.
Patient demographics, characteristics, and surgical modalities were similar between both groups. Tumor complexity was also similar among both groups. A multivariable linear regression analysis revealed no relationship between the operative time and nephrometry score, surgical approach, number of renal arteries, or tumor volume.
The perioperative Likert-scale surveys revealed improved surgeon understanding of renal and tumoral anatomy, and of the renal vasculature after viewing the CT plus iVR model as compared to viewing the CT alone. In 88% of cases, after viewing the CT plus iVR model, surgeons altered their initial CT-based surgical plan. CT plus iVR patients had a 48-minute decrease in operative time.
There were no significant changes in ischemia time, estimated blood loss, or length of hospital stay. There was one Clavien IIIB and one Clavien II complication in the CT plus iVR group versus three Clavien I complications in the CT only group.
In conclusion, preoperative viewing of an interactive, immersive virtual reality model prior to a partial nephrectomy improved understanding of the renal anatomy, altered surgical planning, and reduced operative time by 48 minutes. Thank you.
Eman Chaudhri: Dear viewers, my name is Eman Chaudhri, and I am the leadership and Innovation fellowship training program research scholar here at the University of California, Irvine Department of Urology. It is my pleasure to present our prospective, randomized evaluation of viewing a CT-based, immersive virtual reality prior to laparoscopic or robotic partial nephrectomy, and its impact on surgeon approach and outcomes.
Review of cross-sectional computed tomography, or CT imaging, is crucial for surgical planning prior to a laparoscopic or robotic partial nephrectomy. Recent advances in immersive three-dimensional virtual reality, or 3D iVR modeling, enable the distillation of thousands of CT images into a spatially accurate model, wherein the surgeon can selectively interact with the renal anatomy.
Herein, we evaluated the impact on surgical outcomes of viewing the CT plus a 3D iVR model prior to a partial nephrectomy versus viewing the CT alone. Between 2020 and 2024, 32 patients with a clinical stage T1a renal mass undergoing a minimally invasive partial nephrectomy were randomized into one of two groups, either CT plus iVR model or CT only.
CT scans were utilized to create iVR models utilizing 3D Slicer software. In the CT plus iVR group, the surgeon was able to view and manipulate 3D anatomical components of the model using a Meta Quest headset, as seen here to the right.
Surgeons are able to put on the Meta Quest headset and reposition the anatomical model as they prefer. They are also able to immerse into the separate structures of the model. Additionally, surgeons are able to remove anatomical components as they prefer and move the model to their liking. They are also able to look at the contours of the tumor anatomy and appreciate its relationship to other intrarenal structures.
Surgeons are also able to appreciate structures separately and move them around. Surgeons' appreciation of the surgical anatomy was assessed via Likert-scale surveys. Postoperative parameters, including operative time, ischemia time, hospital stay, and complications to the Clavien-Dindo classification were analyzed.
Patient demographics, characteristics, and surgical modalities were similar between both groups. Tumor complexity was also similar among both groups. A multivariable linear regression analysis revealed no relationship between the operative time and nephrometry score, surgical approach, number of renal arteries, or tumor volume.
The perioperative Likert-scale surveys revealed improved surgeon understanding of renal and tumoral anatomy, and of the renal vasculature after viewing the CT plus iVR model as compared to viewing the CT alone. In 88% of cases, after viewing the CT plus iVR model, surgeons altered their initial CT-based surgical plan. CT plus iVR patients had a 48-minute decrease in operative time.
There were no significant changes in ischemia time, estimated blood loss, or length of hospital stay. There was one Clavien IIIB and one Clavien II complication in the CT plus iVR group versus three Clavien I complications in the CT only group.
In conclusion, preoperative viewing of an interactive, immersive virtual reality model prior to a partial nephrectomy improved understanding of the renal anatomy, altered surgical planning, and reduced operative time by 48 minutes. Thank you.